每日一题_2022.09.09

A 25-year-old man sustains a stab wound to the upper abdomen, with omentum visible on examination. He arrives in the emergency department with a systolic blood pressure of 86 mm Hg and answers questions appropriately.

Which of the following should be done for this patient?

A. Given his normal mental status, a chest and abdominal CT should be obtained to better define his injury and for operative planning.

B. Large-bore IV access should be obtained, and crystalloid and packed red blood cell transfusion should immediately be undertaken until blood pressure is normalized.

C. Emergent local wound exploration should be performed to assess the need for operation.

D. Large-bore IV access should be obtained, and he should be allowed to be hypotensive with no resuscitative efforts until reaching the operating room.

答案解析：

允许性低血压和穿透性创伤延迟复苏的概念越来越受到关注，因为20世纪90年代发表的一项具有里程碑意义的研究表明，该策略降低了死亡率。通过最初的复苏努力增加血压，人们担心初始脆弱的血凝块会脱落，并导致再出血增加。因此，除非该患者的血压进一步下降，或精神状态丧失，否则应立即转移到手术室，并开始复苏。对该患者进行 CT 或局部伤口探查没有作用，因为很明显他的损伤侵犯了腹膜。

正确答案：D